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BDEM2017-0005F= 1 at 78-495 CALLE TAMPICO Ct 0 D 'i �ibNUCl/ LA QUINTA, CALIFORNIA 92253 DESIGN & DEVELOPMENT DEPARTMENT BUILDING PERMIT Application Number: BDEM2017-0005 Property Address: 78441 HIGHWAY 111 . APN: 604050059 Application Description: HARSCH / DEMOLITION OF EXISTING TENANT IMPROVEMENTS Property Zoning: Application Valuation: $25,000.00 VOICE (760) 777-7125 FAX (760) 777-7011 INSPECTIONS (760) 777-7153 Owner: HARSCH INV REALTY 1121 SALMON ST 4TH FL PORTLAND, OR 92253 Date: 6/28/2017 Contractor: HARSCH INV REALTY �-- Applicant: DEACON CONSTRUCTION LLC 1121 SALMON ST 4TH FL 7745 GREENBACK LANE PORTLAND, OR 92253 JUN 2 8 2017 CITRUS HEIGHTS, CA 95610 (916)969-0900 CITY OF LA QUINTA Llc. No.: 1022330 DESIGN AND DEVELOPMENT DEPARTMENT -------------------------------------------------------------------------------------------- LICENSED CONTRACTOR'S DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code, and my License is in full force and effect. License Class: A. B License No.: 1022330 aatt• 6 2$ 20 nRTra 'f�� OWNER -BUILDER DECLARATION I hereby affirm under penalty of perjury that I am exempt from the Contractor's State License Law for the following reason (Sec. 7031.5,.Business and Professions Code: Any city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to its issuance, also requires the applicant for the permit to file a signed statement that he or she is licensed pursuant to the provisions of the Contractor's State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penalty of not more than five hundred dollars ($500).: I ) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale. (Sec. 7044, Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work himself or herself through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.). I ) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project. (Sec. 7044, Business and Professions Code: The Contractors' State License law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a contractor(s) licensed pursuant to the Contractors' State License Law.). (- ) I am exempt under Sec. . B.&P.C. for this reason Date: Owner: CONSTRUCTION LENDING AGENCY I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name:_ Lender's Address: WORKER'S COMPENSATION DECLARATION hereby affirm under penalty of perjury one of the following declarations: _ I have and will maintain a certificate of consent to self -insure for workers' ompensation, as provided for by Section 3700 of the Labor Code, for the performance fthew, rk for which this permit is issued. I have and will maintain workers' compensation insurance, as required by ection 3700 of the Labor Code, for the performance of the work for which this permit is ;sued. My workers' compensation insurance carrier and policy number are: :arrier: ZURICH AMERICAN INSURANCE COMPANY Policy Number: _ I certify that in the performance of the work for which this permit is issued, I hall not employ any person in any manner so as to become subject to the workers' :ompensation laws of California, and agree that, if I should become subject to the vorkers' compensation provisions of Section 3700 of the Labor Code, I shall forthwith :omply with those provisions. ?O I% Aool�np /moi, hi WARNING: FAILURE TO SECURE WORKERS' COMPENSATION COVERAGE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($100,000). IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTORNEY'S FEES. APPLICANT ACKNOWLEDGEMENT IMPORTANT: Application is hereby made to the Building Official for a permit subject to the conditions and restrictions set forth on this application. 1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this application , the owner, and the applicant, each agrees to, and shall defend, indemnify and hold harmless the City of La Quinta, its officers, agents, and employees for any act or omission related to the work being performed under or following issuance of this permit. 2. Any permit issued as a result of this application becomes null and void if work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the above- mentioned property for inspection purposes. ^ , ` Date: 6/28/2017 Application Number: BDEM2017-0005 Owner: Property Address: 78441 HIGHWAY 111 HARSCH INV REALTY APN: 604050059 1121 SALMON ST 4TH FL Application Description: HARSCH / DEMOLITION OF EXISTING TENANT IMPROVEMENTS PORTLAND, OR 92253 Property Zoning: Application Valuation: $25,000.00 Applicant: Contractor: HARSCH INV REALTY DEACON CONSTRUCTION LLC 1121 SALMON ST 4TH FL 7745 GREENBACK LANE PORTLAND, OR 92253 CITRUS HEIGHTS, CA 95610 (916)969-0900 -----------------------------------------------------------------------------------=- Llc. No.: 1022330 Detail: DEMOLITION OF EXISTING TENANT IMPROVEMENTS, INCLUDING PARTITION WALLS, CEILINGS ------- AND LIGHTING FIXTURES, FLOOR FINISHES, MECHANICAL AND PLUMBING INSTALLATIONS AND BACKUP GENERATOR AND ASSOCIATED CMU ENCLOSURE AND ELECTRICAL INSTALLATION. ITEMS TO REMAIN ARE AS FOLLOWS: SUBPANEL AND BATHROOMS. SEPARATE PERMIT IS REQUIRED FOR FUTURE IMPROVEMENTS AND BUILDING OCCUPANCY. 2016 CALIFORNIA BUILDING CODES. •"INFORMATION: DESCRIPTION ACCOUNT QTY AMOUNT Credit Card Fee 101-0000-43505 0 $2.11 Total Paid for Credit Card Fee: $2.11 DESCRIPTION ACCOUNT QTY AMOUNT DEMOLITION, FULL 101-0000-42404 0 $25.84 DESCRIPTION - ACCOUNT QTY AMOUNT DEMOLITION, FULL PC 101-0000-42600 0 $91.20 Total Paid for DEMOLITION: $117.04..